The New York Times, which seems to be absolutely enthralled with Peter Singer, has a long essay written by him in its magazine section right now – and which will be in Sunday’s edition.
Titled “Why We Must Ration Health Care,” it’s a complex discussion of public policy and health care drawing on a multitude of facts, statistics, surveys and studies.
Complex, that is, until he gets to a certain segment of the population. Then he relies solely on the “hypothetical.” That segment of the population would be people with disabilities, of course:
Health care does more than save lives: it also reduces pain and suffering. How can we compare saving a person’s life with, say, making it possible for someone who was confined to bed to return to an active life? We can elicit people’s values on that too. One common method is to describe medical conditions to people — let’s say being a quadriplegic — and tell them that they can choose between 10 years in that condition or some smaller number of years without it. If most would prefer, say, 10 years as a quadriplegic to 4 years of nondisabled life, but would choose 6 years of nondisabled life over 10 with quadriplegia, but have difficulty deciding between 5 years of nondisabled life or 10 years with quadriplegia, then they are, in effect, assessing life with quadriplegia as half as good as nondisabled life. (These are hypothetical figures, chosen to keep the math simple, and not based on any actual surveys.) If that judgment represents a rough average across the population, we might conclude that restoring to nondisabled life two people who would otherwise be quadriplegics is equivalent in value to saving the life of one person, provided the life expectancies of all involved are similar.
For Singer, this is a typical maneuver when promoting the devaluation of people with disabilities. He doesn’t bother to use any empirical base for his assertions, and he probably figures he won’t need to. For one thing, he can pretty much count on the prejudices of the nondisabled readership of the paper to take what he’s said here as objective. Second, since people have imperfect memories, many readers are likely to remember his “hypothetical figures” as facts – since so much of the analysis is based on using some sort of informational source (even individual stories are an information source and a source Singer favors).
After asserting that value-based formulas (or rather formulas that devalue PWDs) must form the basis for allocation of health care resources, Singer continues:
Some will object that this discriminates against people with disabilities. If we return to the hypothetical assumption that a year with quadriplegia is valued at only half as much as a year without it, then a treatment that extends the lives of people without disabilities will be seen as providing twice the value of one that extends, for a similar period, the lives of quadriplegics. That clashes with the idea that all human lives are of equal value. The problem, however, does not lie with the concept of the quality-adjusted life-year, but with the judgment that, if faced with 10 years as a quadriplegic, one would prefer a shorter lifespan without a disability. Disability advocates might argue that such judgments, made by people without disabilities, merely reflect the ignorance and prejudice of people without disabilities when they think about people with disabilities. We should, they will very reasonably say, ask quadriplegics themselves to evaluate life with quadriplegia. If we do that, and we find that quadriplegics would not give up even one year of life as a quadriplegic in order to have their disability cured, then the QALY method does not justify giving preference to procedures that extend the lives of people without disabilities over procedures that extend the lives of people with disabilities.
This alleged interest Singer puts forth in soliciting the evaluations of quadriplegics isn’t something I take too seriously. He’s spent enough time in the field to know that there are plenty of medical professionals who are operating on the assumption that life with a significant disability isn’t worth living – and acting on those assumptions. Just ask Terrie Lincoln and Baroness Jane Campell.
Singer finishes his assault on people with disabilities with the following:
If life with quadriplegia is as good as life without it, there is no health benefit to be gained by curing it. That implication, no doubt, would have been vigorously rejected by someone like Christopher Reeve, who, after being paralyzed in an accident, campaigned for more research into ways of overcoming spinal-cord injuries. Disability advocates, it seems, are forced to choose between insisting that extending their lives is just as important as extending the lives of people without disabilities, and seeking public support for research into a cure for their condition.
This is nothing less than a deliberate dumbing-down of the issues surrounding medical research and disability. First, there are disability advocates who say they are concerned with the way “cure” research is pitched to the public – concerned with the way in which medical research is seen as more important than including and accommodating the people with disabilities that are trying to live their lives. There’s no excuse for this misrepresentation – Singer made much of his assocation with Harriet Johnson, who was proud of her participation in Jerry’s Orphans – a group of people with disabilities who regularly protest that cure-oriented fundraising event. Most recently, self-advocates who have autism have joined the list of people saying they aren’t interested in a cure.
Most people with disabilities don’t think too much about “cures,” but many would approach any “cure” with some careful apprehension: What are the benefits? What are the risks?
Again, typically for Singer, what he’s saying is this: If we’re going to debate or discuss the positions of disability advocates, then these terms that I’ve laid out are the ones that we’re going to use.
If that sounds like Pat Buchanan laying out the terms for a discussion of racial discrimination, you’d be right. As a white male, Buchanan is representative of the type of cultural conservative who demands to lay out the terms for discussing racial discrimination and injustices in this country. As a regular watcher of MSNBC in the morning before work, I get to see him do his schtick on a regular basis.
While Buchanan and Singer may not agree on other issues, their tactics for dealing with debate have some similarities. –Stephen Drake
Dear God in Heaven, it is shameful that a supposed scientist has faith that he can mathematically objectify the entirely subjective — the value any person places on his or her life.
I think he is projecting his irrational emotional fears onto private questions he drags into the public forum in search of validation.
On the one hand, after reading all the way through Singer’s essay, the use of quadriplegia in making his case was nothing more than a big thought experiment.
On the other hand, why does disability always have to figure in to his thought experiments? You are right about fuzzy memory, Steve. If people don’t realize that it was nothing more than a thought experiment, and if they start “remembering” is hypothetical numbers as facts that they “might have read somewhere,” then it all becomes an experiment gone awry.
FYI: Singer made a major error in his essay: He claimed that the NHS in the UK didn’t fund Sutent, because of the price.
But they changed their mind a few months ago.
He also claimed that Sutent only prolonged life “a few months”.
The “median survival” is at least 24 months…and counting.
So far, no correction has been done.
And of course don’t forget Singer might support infanticide, but he also has written that sex with Fido is okay if you don’t hurt him.
Who hires these people?
In my opinion, the New York Times’ infatuation with Singer is the same as embracing his marginalization of the disabled, and, in fact, is promoting said belief. This passive-agressive fear-based tactic is very effective — especially among those who have no experience or contact with a disabled person.
No human being is worth more or less than any other.
I like the way you view the Singer material. I postponed reading the blog post until I was ready to read without “seeing red”, as Singer words often provoke.
As an artist, once-upon-a-time history grad student (pre-art), my reaction is: the hypothetical is so unreal, I don’t need to pick at it.
The basis Singer is building on is
like a cloud:air, water and holds not much.
One does not get to chose how long one wants to have a particular disability, nor to trade it. There has been some popular culture with “would you rather have….” a or b disability.
Would you trade? Movies on quadriplegia have been so off: such
as “Whose Life is it anyway?” and the more recent one about a woman boxer.
I had a twenty year (plus or minus) friendship with an artist with quadriplegia disability. He
could use a pen/brush with a splint
on his wrist. I have known artists who paint holding brush in mouth, or foot or attached to a headband. I mention all that because people have little idea of
what disability is really like.
My pal who died about two years ago from MRSR strep infection after three weeks in a hospital, where he was taken for treatment for bedsores (from sitting) – a large regional hospital. He didn’t die from his
disability. He and I had a similar wry sense of humor, although he was from a SW state and the only male chauvist I knew.
When he died, his sister called me and when I quipped, “Well, he didn’t feel the sores or the infection”, she said he’d made the same joke in the hospital. (No pain due to paralysis and no feeling in that place.)
If people knew people with disabilities (and usually do, if they haven’t avoided someone in their own fear), if people with severe disabilities were given choice is living at home rather than locked up in institutions (or home), Singer’s views would be more apparent to the general population as bizarre. That he is a prof. of ethics in a university is indicative of what a mess our society is in, in part.
Except, I don’t remember PB ever arguing in support of killing anyone.
Gary,
I cannot claim to know Singer’s motives, save the most obvious one – his consistent advancement of the idea that public policy should be based on his interpretation of utilitarian principles.
Mike, building on the point I made with Gary – this is more than a “thought experiment.” It’s an argumentation technique aimed at furthering Singer’s ideas on how public policy should be shaped. I think that too many people automatically assume he’s occupying the intellectual high ground. This guy participates in animal rights demonstrations and has been known to sit in a chicken coop during a protest – he understands theater and appeal to emotions. –Stephen
Don’t we all believe that public policy should be based on our interpretation of our principles, whatever they may be?
boinky,
If you read this response, I’d love to see a link or two re: Sutent. It wouldn’t be the first time Singer got his facts wrong. Empirical data just isn’t that important in the world of bioethics.
SAFEPres,
who is PB?
PB is Pat Buchanan. Despite being more conservative than I am (I’m a moderate and differ with him on several social issue) I am certain that he would not support murdering infants because they are disabled, as
Singer does. Maybe PB says some things that could be construed as racist, but he hasn’t suggeted killing black people or denying them medical care, which is what Singer does. So, in my view, the two aren’t necessarily comparable because one advocates killing people and the other says things that are politically incorrect. I don’t watch Buchanan so I couldn’t say whether he has race issues, although I’m sure that he does not support racist policies in the classic sense of the term, which, conversely, Singer advocates policies that are ableist according to anyone’s definition-he admits it-you won’t see PB running around screaming, “I’m a racist and I like it,” but that is just what PS is doing, except he’s an ableist.
Fuck you Retard!
Disabled freaks should all die!
Stop using air and water and food real people need!
Dear Anonymous,
Thank you for submitting your eloquent and thoughtful support for Singer’s policy proposals. Normally, I’d just delete an anonymously posted piece of crap like this, but it’s nice piece of evidence of the (cough) quality of some of Singer’s supporters.
Believe it or not, it’s refreshing to be on the receiving end of unvarnished hatred like this once in awhile. Don’t ever change.